Ovarian cysts are sacs filled with fluid that are present in or on the ovaries.
They are very common, and as such, many women will develop them at some point in their lifetime.
Most ovarian cysts occur naturally as a result of undeveloped follicles or unmatured eggs during the normal menstrual cycle.
Usually, these cysts are harmless and will disappear naturally on their own after a few months, without the need for medical attention.
However, there is a condition that is characterised by the appearance of multiple cysts in the ovaries, which can have an effect on a woman’s health.
This condition is known as polycystic ovary syndrome (PCOS).
What is PCOS?
PCOS is a common hormonal and reproductive disorder in women of reproductive age.
It is estimated to affect 5-10% of the female population, and is one of the most common causes of irregular periods and infertility in young women.
Women with PCOS have very few periods (oligomenorrhoea) or no periods at all (amenorrhoea).
Sometimes, they can have irregular periods with a prolonged bleeding pattern.
They also typically have higher levels of male hormones (androgens) and may not produce enough of the necessary female hormones needed to make their eggs grow and be released (ovulate).
The inability to ovulate leads to infertility.
They may have multiple fluid-filled sacs in their ovaries (follicles).
Despite the name of the condition, some women may develop ovarian cysts, while others do not.
One of the important things to note about PCOS is that it is often under-diagnosed, or even misdiagnosed.
Who can get PCOS?
Any woman in the reproductive age may be affected by PCOS.
Although genetics do not appear to play a role in this condition, you may be more predisposed to getting PCOS if your mother, sister or other female relatives have it.Based on clinical experience, women with PCOS tend to present with symptoms starting in their late 20s or early 30s.
This is when many women would be trying to conceive.
What causes PCOS?
It is a condition that remains rather a mystery to date.
PCOS is thought to be a metabolic condition of hormonal imbalance, but the exact cause is unknown.
There are many factors that contribute to PCOS, including insulin resistance (which also increases the risk of developing type 2 diabetes) and male hormone production.
When should you suspect you might have PCOS?
The typical symptoms and signs of PCOS are:
You may have a long gap between two period cycles, or sometimes, no periods at all, despite not being pregnant.
Some women may notice abnormal menstrual-like spotting, which is likely to be breakthrough bleeding, rather than an actual menstrual period.
Women with PCOS tend to gain weight, even when they seem to be on a well-controlled diet.
This is related to their underlying insulin resistance.
However, this does not necessarily apply to all cases.
This is the symptom that most commonly leads to a woman having her PCOS diagnosed.
The infertility results from an inability to ovulate or uncertainty of the ovulation day, which makes it hard for the woman to know her fertile window in order to maxi-mise the chances of conception.
These symptoms are usually caused by having higher levels of male hormones (hyperandrogenism) than is typical in a female.
These are patches of dark, velvety and thickened skin patches.
They are often located along the neck creases, underneath the breast or along the groin.
How is PCOS diagnosed?
There are several different diagnostic criteria used around the world to diagnose PCOS, but the most commonly used one is the Rotterdam Criteria.
This criteria requires the woman to have at least two out of three of the below signs/symptoms to be diagnosed with PCOS:
- Oligomenorrhoea or amenorrhoea
- A polycystic ovary (seen via imaging like ultrasound), and
- Hyperandrogenism (confirmed either physically or biochemically).
However, many women may fall into the grey zone of the diagnosis spectrum.
Therefore, they should discuss with their gynaecologist regarding the possibility of having PCOS.
What to do if you have PCOS?
First of all, do not fret, PCOS is not a life-threatening condition.
There is no increased risk of ovarian cancer, breast cancer, or any other gynaecological cancer such as vulva, cervical or vaginal cancer.
However, women with PCOS might be slightly at risk of uterine cancer as the inner lining of their uterus can become very thick due to the non-shedding caused by irregular or no menstruation.
When the endometrium becomes too thick, it is characterised as endometrial hyperplasia.
Endometrial hyperplasia itself is not cancer, but in some cases, it can lead to cancer of the uterus.
Discuss with your gynaecologist regarding treatment options, which will depend on your need, e.g.:
Every woman with PCOS can get pregnant.
However, the fertility journey may differ from one to another.
Some women conceive once regular ovulation is induced via medication, while others need advanced fertility treatments such as an intrauterine insemination (IUI) or in-vitro fertilisation (IVF).
In a minority of women who do not respond to medication for ovulation, laparoscopic ovarian drilling may be considered.
This minimally-invasive surgical procedure helps to decrease the amount of male hormones produced, thus encouraging ovulation.
All other available medical techniques to induce ovulation should have been tried before opting for ovarian drilling, and the woman should fully understand the risks and benefits before undergoing this procedure.
Treatment options for infertility also depend on the male partner’s fertility test and other female infertility factors, like the patency of the Fallopian tubes.
It is fine not to have menstrual periods every single month.
If your menstrual cycle comes consistently once every five to eight weeks, it is not wrong to let it be.
However, if you desire a monthly bleeding pattern, you may need to implement some lifestyle changes, and perhaps take hormonal treatment.
For women with PCOS, one of the most natural drug-free treatments is to reduce their body weight.
This is easier said than done, but a weight loss of as little as 5% of your current weight has been shown to be beneficial.
Ideally, aim for a minimum weight loss of 10% – this has the best effect in lessening symptoms, including resumption of periods and improving fertility.
There are also hormone tablets, such as combined oral contraceptive pills or pills containing progesterone, which regulate female hormones and the menstrual cycle.
These medications prompt a period known as a withdrawal bleed between cycles, which gives an effect similar to a natural monthly period.
This withdrawal bleed also helps to lower the risk of endometrial hyperplasia.
Please ensure that you have at least four to five menstrual bleeding cycles per year.
Hormonal treatment may help to control the levels of male hormones that result in excessive body hair (especially facial hair).
However, if such treatment fails to achieve adequate control, you may consider physical treatments such as waxing, treading, depilatories and electrolysis.
Women with PCOS are at increased risk of developing metabolic syndrome.
Therefore, they should do an annual check for type 2 diabetes, high blood pressure (hypertension) and high cholesterol levels.
They would also benefit the most from healthy lifestyle changes.
Living well with PCOS requires a proactive approach to adopt an active lifestyle with a healthy balanced diet.
A change in diet and activity may result in weight loss, which can often reduce the symptoms.
It can also help the body use insulin more efficiently, thus lowering blood glucose levels and even helping ovulation.
Over the last two years of the Covid-19 pandemic and resulting movement control order, there appears to be an increase in the number of young women being diagnosed with PCOS.
In many of these cases, the lack of exercise and the adoption of a sedentary lifestyle caused by working from home appeared to trigger irregular periods or a lack of period in these women for the first time.
This might be due to weight gain during this period unmasking their underlying PCOS.
In fact, most patients diagnosed with PCOS due to their sedentary lifestyle or physical inactivity start getting their symptoms under control, or even see them disappearing, once they get to a healthy weight.
Therefore, for women with PCOS, it is imperative to not solely rely on medication (hormone-regulating pills) for treatment, but to also incorporate a healthy diet and sufficient exercise for weight reduction or healthy weight maintenance.
These actions play an important role in regulating the menstrual cycle, as well as reducing the chances of endometrium hyperplasia and the risk of developing uterine cancer.
With a healthy weight, disorders commonly associated with PCOS such as obesity, ischaemic heart disease and type 2 diabetes can also be prevented.
Some women with PCOS may also experience mental health issues such as depression, anxiety and eating disorders.
Seek help early from a mental health professional if you experience these symptoms.
Can PCOS be cured?
PCOS is a lifelong condition with no known cure.
Fortunately however, the undesirable symptoms and signs of PCOS can be well controlled in many women.
Strategies to control the symptoms vary from patient to patient, and it is best to discuss and decide on your options together with your gynaecologist.
Although women with PCOS may have to deal with infertility and various health problems, these challenges can be overcome with the right help and guidance by a specialist doctor.
Dr Agilan Arjunan is a fertility specialist and Dr Michael Lim Chung Keat is a gynaecological oncologist. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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